The National Health Service (NHS) is experiencing an "out of control" and "unsustainable" surge in spending on diagnosing autism and attention deficit hyperactivity disorder (ADHD), according to a new report by the NHS Alliance. Spending on these diagnoses has increased tenfold in the past year, with private clinics charging up to £3,000 per patient.
The escalating costs are forcing some regions to reduce essential services for individuals with learning disabilities to meet the demand for ADHD assessments. The NHS Alliance, which represents health trusts, stated that the current system is failing both patients and taxpayers. Managers are finding it difficult to ensure the quality and safety of care due to the "relentless rise" in spending across the 42 NHS care boards.
Referrals for ADHD have seen a twenty-fold increase since the turn of the century, with approximately 800,000 people currently awaiting an assessment in England. NHS England estimates that around 2.5 million people in England live with ADHD, many of whom remain undiagnosed.
The "Right to Choose" initiative, which allows patients to be assessed by private providers with the NHS covering the cost, is identified as a major driver of this spending increase. This has led to what the NHS Alliance describes as a "Wild West" of private clinics, with some conducting diagnostic assessments online.
Specific examples highlight the scale of the financial strain. One integrated care board reported a monthly spending increase from £146,000 to £1.5 million for autism and ADHD services. In Kent and Medway, spending rose from under £1 million in 2023-24 to £28.9 million this year, while Cheshire and Merseyside project adult ADHD service costs to increase from £11 million to £51 million by 2026-27.
The NHS Alliance is calling for a national fixed tariff to cap the charges of private clinics for ADHD and autism services. Experts warn that without such measures, NHS spending will continue to escalate uncontrollably. Thea Stein, chief executive of the Nuffield Trust, noted that increased spending in one area necessitates cutbacks elsewhere.
The report also calls for a national service specification to ensure high-quality assessments as part of a new national approach to autism, ADHD, and mental health. Kent and Medway have introduced a prioritisation scheme for children and young people with the greatest clinical need, and are considering similar measures for adults, though concerns remain about longer waiting times for those not fast-tracked.
Experts suggest that rising demand is fueled by increased awareness of ADHD, better symptom recognition, and discussions on social media, rather than a genuine increase in the condition's prevalence. High-profile individuals, including actors Sheridan Smith and Robbie Williams, have publicly shared their diagnoses, which campaigners believe has helped reduce stigma and encourage others to seek help.
An NHS spokesperson acknowledged the long waiting times and stated that actions are being taken to improve access and ensure value for money. The next phase of an independent prevalence review is expected to inform future service development. An interim report in March identified "institutional incentives" that encourage diagnosis, potentially linked to adjustments in educational or work settings. The rise in diagnoses also occurs against a backdrop of increasing mental health issues, such as depression and anxiety, since the pandemic.